PARP-inhibition and CTLA-4 Blockade in BRCA-deficient Ovarian Cancer

Prior treatment

• Recovery from effects of recent surgery, radiotherapy, or chemotherapy must be demonstrated
• Hormonal therapy directed at treatment for the cancer must be discontinued at least 1 week prior to enrollment. Hormone replacement therapy for symptom management is permitted.
• Any other therapy directed at treating the cancer including chemotherapy, biologic/targeted agents, and immunologic agents, must be discontinued at least 3 weeks prior to enrollment.
• Any prior radiation therapy must be discontinued at least 4 weeks prior to enrollment.
• A history of autoimmune disorders other than vitiligo (e.g., psoriasis, extensive atopic dermatitis, asthma, inflammatory bowel disease, multiple sclerosis, uveitis, vasculitis), chronic inflammatory condition, or any condition requiring concurrent use of any systemic immunosuppressants or steroids for any reason are excluded from the study. Any patient with an allo-transplant of any kind would be excluded as well, including xenograft heart valve. Mild, intermittent asthma requiring only occasional beta-agonist inhaler use or mild localized eczema will not be excluded.
• Concomitant use of known potent cytochrome P450 isoform 3A4 (CYP3A4) inhibitors
• Patients who are receiving any other investigational agent
  • For Phase 2, the inclusion/exclusion criteria above apply. In addition, the following exclusion criteria apply:
• Patients who have previously received anti-CTLA-4 antibody therapy

Other illness

• Patients should be free of active infection requiring antibiotic therapy (except for uncomplicated urinary tract infections)
• Chronic use of immune-suppressive drugs (i.e., systemic corticosteroids used in the management of cancer or non-cancer related illnesses, e.g., COPD).
• Known HIV-positive patients and those with other acquired/inherited immunodeficiencies are ineligible due the possibility of affecting the response to tremelimumab, and the higher risk of active opportunistic infections.
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to olaparib or tremelimumab, or other agents used in study.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Persistent toxicities (\> Common Terminology Criteria for Adverse Event (CTCAE) grade 2) caused by prior cancer therapy, excluding alopecia

Lab values

• Resting electrocardiogram with corrected QT interval (QTc) \>470msec on two or more time points within a 24hr period, or a family history of long QT syndrome

Other

• Must not be pregnant or nursing as the potential of this regimen to harm nursing infants has not been evaluated.

• Patients must have recurrent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma for which standard curative measures do not exist.
• Patients must have a confirmed germline mutation in the BRCA1 or BRCA2 gene
• Patients must have measurable disease as defined by World Health Organization (WHO) criteria: at least 1 lesion that can be accurately measured in at least 1 dimension (longest diameter to be recorded). Each lesion must be \>1.0cm when measured by CT, MRI, or caliper measurement by clinical exam; or \>2.0cm when measured by chest x-ray. Lymph nodes must be \>1.5cm in short axis when measured by CT or MRI
• Patients with platinum-sensitive or platinum-resistant disease are eligible
• Patients must have received at least 1 prior course of platinum-based chemotherapy for the management of primary disease including carboplatin, cisplatin, or another platinum compound
• There are no restrictions on the total number of prior regimens patients may have received
• Gynecologic Oncology Group (GOG) performance status of 0, 1, or 2
• Adequate organ and marrow function as defined below:
  • Absolute neutrophil count (ANC) \>1,500/mcl
  • Platelets \> 100,000/mcl
  • Creatinine \< 1.5x the institutional upper limit of normal (ULN)
  • Bilirubin \< 1.5x ULN
  • Aspartate aminotransferase and Alanine aminotransferase \< 3x ULN
  • Alkaline phosphatase \< 2.5x ULN
• Women of child-bearing potential must have a negative pregnancy test prior to study entry and agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 180 days following completion of therapy
• Ability to understand and the willingness to sign a written informed consent document
• Patients must meet pre-entry requirements as specified